Provider Demographics
NPI:1124227814
Name:WATSON, LARRY DAN (MSSW)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:DAN
Last Name:WATSON
Suffix:
Gender:M
Credentials:MSSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 GWYNDELLONS LN
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-3614
Mailing Address - Country:US
Mailing Address - Phone:972-740-5422
Mailing Address - Fax:
Practice Address - Street 1:604 GWYNDELLONS LN
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-3614
Practice Address - Country:US
Practice Address - Phone:972-740-5422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX042451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical